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New-Onset Atrial Fibrillation After PCI or CABG for Left Main Disease: The EXCEL Trial

Ioanna Kosmidou1, Shmuel Chen2, A Pieter Kappetein3

  • 1Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Arrhythmia Center, Department of Cardiology, St. Francis Hospital, Roslyn, New York.

Journal of the American College of Cardiology
|February 16, 2018
PubMed

Insights

New-onset atrial fibrillation (NOAF) is common after coronary artery bypass grafting (CABG) but rare after percutaneous coronary intervention (PCI) for left main coronary artery disease. NOAF after CABG significantly increases the risk of stroke and death.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Limited data exists on new-onset atrial fibrillation (NOAF) incidence and outcomes post-revascularization for left main coronary artery disease (LMCAD).
  • Understanding NOAF's impact after PCI versus CABG is crucial for patient management.

Purpose of the Study:

  • To assess the incidence of NOAF following PCI and CABG in LMCAD patients.
  • To evaluate the 3-year cardiovascular outcomes associated with NOAF post-revascularization.

Main Methods:

  • Analysis of the EXCEL trial data, randomizing 1,905 LMCAD patients to PCI or CABG.
  • Outcomes were compared between patients who developed NOAF during hospitalization and those who did not.

Main Results:

  • NOAF occurred in 18.0% of CABG patients versus 0.1% of PCI patients (p < 0.0001).
  • NOAF was linked to longer hospital stays, increased anticoagulant use, and higher bleeding rates.
  • NOAF post-CABG independently predicted 3-year stroke (aHR 4.19), death (aHR 3.02), and composite endpoints (aHR 2.13).

Conclusions:

  • NOAF is frequent after CABG but rare after PCI for LMCAD.
  • NOAF development post-CABG is a significant predictor of adverse long-term cardiovascular outcomes.
  • Further research into prophylactic strategies for NOAF in CABG patients is warranted.
Abstract

Keywords:
atrial fibrillationcoronary artery bypass graftingleft main diseasemortalitypercutaneous coronary interventionprognosisstroke

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